Assessing techniques and outcomes in scrotal reconstruction: A sudanese cohort study.

Introduction: Acquired scrotal defects, most commonly resulting from infection and trauma, present complex reconstructive challenges. This study evaluated the causes and reconstructive outcomes of scrotal defects in a Sudanese multi-center cohort, aiming to (1) identify predominant aetiologies and comorbidities, (2) describe reconstructive techniques and complication profiles, and (3) compare outcomes among different flap types. Materials and Methods: A prospective cohort study was conducted at two Sudanese hospitals from January 2024 to December 2025, including patients with acquired scrotal defects undergoing reconstruction. Data collected included demographics, comorbidities, aetiology, defect size and location, reconstruction timing, surgical technique, and complications. Defects were stratified by surface area involvement. Statistical analysis used descriptive methods and significance testing (p < 0.05). Results: Forty-two patients (mean age 37.4 years) were included; 43% had diabetes. Infection was the leading cause (76%), with diabetes significantly associated with infection-related defects. Most defects were bilateral (67%), and 78% were moderate or large. Reconstruction methods included scrotal advancement (36%), Singapore (31%), TFL (24%), and modified pudendal thigh flaps (10%), with skin grafts for penile resurfacing (7%). Complications occurred in 45%, most often partial flap necrosis and wound dehiscence; complication type was significantly associated with flap type. Conclusion: Infection-often in diabetic patients-was the predominant cause of scrotal defects. Multiple flap techniques provided satisfactory coverage, especially thigh-based flaps for larger defects, with no donor site morbidity. High complication rates emphasize the need for individualized reconstructive strategies, as no single technique proved clearly superior.